Cluster Hospital Initiative (CHI) in Malaysia is a hospital merger exercise to establish an integrated network of specialist and non-specialist hospitals. The resource sharing, services realignment, and better care coordination from this integration have been shown to improve operational efficiency and quality of care from the providers’ perspective. However, there are very limited studies which focus on the effects of hospital merger on patients. Therefore, this study aims to explore patients’ and caregivers’ experiences of CHI. A qualitative study using purposive sampling was conducted from July to August 2017 at the three pilot sites. Semi-structured in-depth interviews were conducted with 85 patients and caregivers who received healthcare services before and after CHI. Interviews were audio-recorded and transcribed verbatim. Data were analysed using thematic text analysis. Three main themes transpired from the analysis were changes in healthcare service delivery, time spent on healthcare-related activities, and financial implications. Firstly, participants were generally satisfied with the increased access to specialist services, better quality of care, and upgraded equipment and facilities. Secondly, many participants experienced a shorter waiting time and reduced travelling time after CHI. Thirdly, CHI led to financial savings for the participants in terms of reduced out-of-pocket expenditure and productivity loss. This study demonstrated that the implementation of CHI appeared to be well-received by the patients. The expected benefits brought on by hospital mergers were also acknowledged by the study participants. A follow-up study is recommended due to the short duration of CHI implementation and low awareness about the initiative among patients.

To address an imbalance between congested specialist hospitals and underutilised district nonspecialist hospitals, Ministry of Health Malaysia introduced Cluster Hospital (CH) in 2014.Following successful implementations from countries with similar healthcare system such as Hong Kong, and Australia, CH merges hospitals to establish an integrated network of specialist and non-specialist hospitals through shared resources, streamlined services and care coordination. A qualitative study was conducted to explore perceived barriers and boosters towards CH implementation and its sustainability among healthcare providers via semistructured focus group discussions and in-depth interviews with purposefully selected respondents from the first six CHs. An Interview protocol was developed based on Consolidated Framework for Implementation Research (CFIR) covering five domains; intervention characteristics, outer setting, inner setting, characteristics of individuals, and process. This paper will only highlight the perceived barriers in the intervention characteristics domain. A total of 274 participants from varying professions were interviewed. Interviews were audiorecorded, transcribed and thematic analysis was performed. In this domain, barriers to implementation were found within three constructs; complexity, design quality & packaging, and cost. Issues highlighted include intervention was designed with vague guidelines & policies, distance and travel costs within a CH, medical record safety, huge capital and operating cost involved. It was found that adaptation of evidence-based interventions needs to take into account the local context of an organisation for the implementation to be successful and produce desired outcomes. Thus, these perceived barriers raised by ground-level implementers should be considered and acted upon when strategising towards CH sustainability.